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Differences between patients with heart failure treated by cardiologists, internists, family physicians, and other
1Section of Heart Failure & Cardiac Transplantation, Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI 48202, USA. ephilbi1@hfhs.org
Insights
Cardiologist management of heart failure (HF) is cost-effective, with similar outcomes to other physicians. Further research is needed to optimize physician staffing for HF care.
Area of Science:
- Cardiology
- Health Services Research
- Health Economics
Background:
- Cardiologists' adherence to heart failure (HF) guidelines may improve care quality.
- The cost-effectiveness of cardiologist-led HF management compared to other physician specialties is debated.
Purpose of the Study:
- To compare the cost-effectiveness and clinical outcomes of heart failure (HF) management by cardiologists versus other physicians.
- To analyze resource utilization and short-term outcomes based on physician specialty in HF care.
Main Methods:
- Retrospective analysis of 1995 New York state hospital discharge data for heart failure (HF) patients.
- Comparison of demographic, clinical, process of care, resource utilization, and outcome data between patients managed by cardiologists and other physicians.
- Statistical analysis of 44,926 identified HF cases, categorized by managing physician specialty.
Main Results:
- Patients managed by cardiologists were younger, more male, and had fewer comorbidities but similar adjusted hospital length of stay and charges compared to other physicians.
- Cardiac catheterization rates were higher for cardiologist-managed patients, yet mortality and readmission rates for HF were similar across specialties.
- Patients managed by "other" physicians (primarily surgeons) had the longest stays and highest charges, with more invasive procedures.
Conclusions:
- Cardiologist management of heart failure (HF) is not economically disadvantageous.
- Further investigation into physician specialty's impact on HF care processes, resource use, and outcomes is necessary for evidence-based staffing recommendations.
Background:
The management of heart failure (HF) by cardiologists may be better than that of other physicians in that cardiologists' treatment choices more frequently conform with published guidelines and the results of clinical trials. Whether cardiologists' management of HF is more or less cost-effective is up for debate.
Methods:
Information on all 1995 New York state hospital discharges assigned ICD-9-CM codes indicative of HF in the principal diagnosis position was obtained. Demographic and clinical characteristics, process of care, resource utilization, and short-term HF-related outcomes were compared between patients of cardiologists and patients of other physicians.
Results:
A total of 44,926 patients were identified, with 10,506 (23%) receiving care from cardiologists, 28,300 (63%) from internists, 4812 (11%) from family practitioners, and 1308 (3%) from other physicians. Patients of cardiologists were younger, more frequently male, and less frequently residents of nursing homes. They were more likely to have associated cardiovascular diagnoses but less likely to have comorbid general medical conditions. Patients of cardiologists were more likely to undergo cardiac catheterization (9%) than those of internists (3%) and family practice (2%) physicians but had similar adjusted hospital length of stay and charges. Mortality and hospital readmission rates for HF were similar among the groups. Patients in the "other" group (managed mostly by surgeons) were the youngest, underwent more invasive and cardiac surgical procedures, and had the longest length of stay and highest hospital charges.
Conclusions:
Cardiologists' management of HF is not economically disadvantageous. The relations among physician specialty, process of care, resource utilization, and clinical outcomes require further study before rational and evidence-based health care staffing recommendations can be formulated.